David Norris (Independent)

I thank Senator Tuffy for making this time available to me. I have an interest in the Bill for a number of reasons. As a matter of principle, I have always supported independent regulation for professions, including the news media and newspapers in particular, which lash out and ask others to be regulated independently, but are not keen on it for themselves.

While I support independence and it is clear that the medical council as constituted is a self-regulating body, the Minister's proposal is a ministerial takeover. That is worrying, particularly in light of this important legislation being railroaded through the House at the last minute. There is not the slightest chance of amendments from this House being accepted. It is an abrogation of our role, as the Seanad is supposed to be a refining and amending Chamber. Second Stage is to be concluded today while Committee Stage is scheduled for tomorrow and Report and Final Stages for Thursday. That schedule does not leave much time and there will be no amendments.

I will examine the situation and express my concern about the ministerial takeover of the medical council, which reflects the concerns of many people in the medical profession. The first question we must ask is what is the medical council for. It can be answered simply, namely, to ensure the quality of undergraduate and postgraduate medical education, the registration and disciplining of doctors and guidance on professional standards. Under the Bill, the Minister is taking unto herself powers to direct the council on matters of education and policy. She is also giving herself powers to appoint and direct — this is an important issue — the majority of the council and to remove appointees who fail to meet her approval. These provisions make the council amenable to political interference. I regard the current Minister as somebody of high ethical standards who would be very unlikely to try to interfere politically. This legislation is opening the door to such interference, however, which is very dangerous.

The Bill basically proposes to remove the autonomy of the Medical Council and the individual doctor. It will damage the ability of the council and of doctors to act as advocates for patients, in circumstances in which such advocacy is in conflict with the Minister's own ends. That is the problem. Like the Medical Council, doctors should be politically independent and should represent the interests of patients. After this legislation has been passed, it will be possible for politicians and their advisers to devise and construct health policy without having to tolerate the nuisance that might be presented by any serious appraisal of it by health professionals.

I would like to read from a statement on the Bill that has been published on its website by the Medical Council, which has to be taken reasonably seriously in this regard:

The Bill as currently worded may end elements of the Medical Council's independence. As worded, it will allow a future Minister for Health to block Council activities that could be in the interests of patients (but) might give discomfort to officials at a local or national level.

In other words, it is possible that professionals — people with expert involvement, understanding and knowledge of this area — will be muzzled in the interests of political convenience. I also refer to a recent editorial in Forum, the journal of the Irish College of General Practitioners, which is a serious and responsible body. The college represents local doctors who meet the public all the time when they are contacted by those who are sick or in distress. The editorial stated:

The unanimous warning from the profession is that the section on ministerial directions to Council heralds the holding of draconian power by future ministers to dictate policy to the Council. It is the view of the ICGP and the other training bodies as well as the IMO that this effectively abolishes self-regulation and the independence of the Council from political interference. This is deemed (to) be a serious step in the wrong direction for the protection of patients.

It is clear that similar concerns are outlined on the Medical Council's website and in an editorial in Forum which speaks on behalf of general practitioners.

It has been indicated to me that the Medical Council has previously lobbied the Minister actively to give it greater powers so it can regulate more effectively. The council felt that the tools with which it was provided were inadequate for the job. The Medical Practitioners Bill 2007 does not provide for such additional powers, however. It allows the Minister to assign functions to the council relating to education, training and the practice of medicine, as I have already said. The Minister is being given powers that might make it difficult for the Medical Council to be critical of the Government's health care policy, or its funding of medical education. An attempt is being made to muzzle what should be a strong professional voice on behalf of patients. There is a danger that State intrusion in the doctor-patient relationship might interfere with the duty of doctors to act as advocates on behalf of their patients. It is obvious that there will always be tension between the State and individual citizens in the provision of health care.

The Department and the Minister are in an unenviable position. I understand they might feel angst in having to allocate resources to one group of patients rather than another. They might not appreciate the criticism they are getting from certain voices. People such as me have been demanding the provision of further services for people with cystic fibrosis. It is scandalous that the life expectancy of people in Northern Ireland with cystic fibrosis is ten years more than that of their counterparts on this side of the Border. It is scandalous that the resources made available there are not provided here. I understand the Department of Health and Children has some difficulties in making resources available. It is terribly important that people with cystic fibrosis should be represented not only by people like me who are briefed by groups which are concerned about these matters but also by people within the medical profession who push the interests of their patients. I accept that there is tension in this respect, but it is healthy and democratic. It underlines the principle that the doctor works for the patient rather than for the health service, the Department or the Minister for Health and Children.

Some really tragic stories were told as part of a recent series of programmes on RTE television. We learned about some wonderful doctors who engage in passionate advocacy on behalf of their patients. We were told about a woman with no private health insurance who did not get treatment in time because she had to wait six months for her smear test to come back. It is shocking that a woman in a country with substantial resources was sentenced to death, in effect, for the crime of being poor. I do not believe that such criticism will be evident if the Medical Council comprises a row of Government appointees. I have consistently opposed the practice of jamming all kinds of boards with political appointees because it is wrong. There have been arguments in the past about the process whereby members of local authorities are appointed to the boards of third level institutions. When there was a big row about this sort of thing during the debate on the Trinity College Bill, we managed to confine the number of appointees to one. That person has been all right so far, as far as I know. Politicians are notoriously susceptible to the creeping disease of thinking they will be all right if they get one of their own boys on these boards. Such an approach is not in the best interests of the medical profession.

If the Medical Council is to be truly independent and to fulfil its duty to protect the public, it must be free of the Government's control and direct influence on policy. In particular, it must be free of any suggestion that it can be politically muzzled. I have considerable hesitation in endorsing this legislation for that reason. I cannot give it the welcome it was given by Senators from the other side of the House. The Minister of State, Deputy Seán Power, who is a decent man, is standing in for the Minister for Health and Children, Deputy Harney. Will he outline to her the concerns I have expressed? Other Senators may have similar concerns. I was not able to be present in the Chamber for Senator Henry's contribution. I assume she made some similar points, but I am not sure. I simply do not know.